I just got back the results of a 3T-MRI performed 13 weeks post-PAE to assess progress. I was shocked to read in the report that there was a "7mm focus of abnormal signal within the left peripheral zone at mid gland which could represent clinically significant prostate cancer". Yikes!!
Over the past 20 years I have had 3 TRUS 12-needle biopsies - all negative. I was wondering if anyone else ever got a similar report which could be caused by the scars left by the needle biopsies?? Also could the PAE itself cause this signal since I will still have tissue scarring?
I did have liquid biopsies for PCa last year (MiPS and Apifiny) that look at the molecular level in urine and blood samples for cancer biomarkers and both tests were very good.
My uro said to speak with my IR guy (and added that he told me not to do the PAE). On the positive side the MRI did show about a 40% reduction in my prostate volume from 280gm to 175gm though strangely I have not seen any symptom improvements.
Any help on the MRI-scare would be much appreciated.
Way beyond my pay grade but I did have an MRI last year which suggested in slightly less alarming words an unidentified mass in my bladder that required more examination. Translated that meant I needed a cystoscopy of the bladder to rule out prostate cancer. Had the cystoscopy and no prostate cancer.
I do realize that in your case it's not the bladder, but I offer my situation to show that just because an MRI sees something suspicious doesn't mean it's necessarily cancer. So hopefully that will be the case with you as well. What are the next steps to figure out what is going on?
As to your prostate reduction from PAE without symptomatic relief, often left out of the doc's pitch is that it's not just the prostate size that causes bph symptons but more importantly in many cases it's your bladder tone.
I had "severe" symptons based on the IPSS score before I rehabbed my bladder with CIC. Now they are "mild". Since I never had any sort of procedure or operation the size of my prostate never changed. If anything it probably got better. So with me, almost complete symptomatic bph relief without any reduction in prostate size. Also, studies suggest that many people with large prostates have no bph symptons while many with smaller prostates do have symptons. Again, there seems to be too much concentration on prostate size versus what is actually causing the bph symptons. Cut, cut, burn, steam isn't always the cure or the best option.
I had a 3T MRI that showed a lesion with a PIRADS score of 4/5, which signifies clinically significant cancer is likely to be present. I then had a targeted biopsy which came back negative. Uro Doc said BPH nodules can look like PCa lesions. Wish he would have told me that when the MRI report came rather than waiting until after the biopsy!!
The next step would be to biopsy the area that showed up on the MRI. Then, the samples would be given a Gleason grade. If this area does show some prostate cancer and if it is only in one area, you would be a candidate for focal therapy - treatment of the prostate that only effects one area - not the entire gland.
The PAE did reduce your prostate volume from 280gm to 175gm - a huge improvement. However, 175 is still a very large prostate, so it isn't surprising that you are still having symptoms of BPH.
HOLEP is the procedure that is normally recommended for extra large prostate volumes - very effective. However, if you do have a 7mm area of prostate cancer then you would want to have this treated first. 7mm is not that unusual. Sound like some of my prior biopsies. What is critical is the Gleason grade, the number of cores positive, and any other areas that show up. So, there is certainly more investigating to be done before you have to make any decisions.
Hi Jim - I can always count on you for new insights - thanks.
You make a good point about the weak bladder tone and my IPSS still being up at 30 even with a good response to PAE.
But back in the summer when I went into AUR and didn't know how to self-cath I would take prednisone for a few days ( a really bad drug) and my peeing really was like your proverbial race horse! My IPSS score at that time would be 0. But it only lasted for a few days and then reverted back. So doesn't that say that my bladder muscle was still good? I could actually hit a target with my stream 6 feet away and my full sexual function returned too. To me it seemed my BPH was all inflammation but I don't know.
My uro wants my IR guy to comment on the report first but I cannot reach him. He wants to know if this type of scan is typical of PAEs.
I am still in shock. I used to write guys on this forum who were down about their BPH to go over to the prostate cancer threads and see what those guys deal with and then they wouldn't be so down. Gee whiz... Neil
Hi Rich - thanks for responding. The report said the PIRADS category was 4 - I thought that was part of the machine description! I guess I will also have targeted biopsy but I am stuck between 2 doctors - a uro and an interventional radiologist who don't seem to like each other.
Did you ever have a TRUS core biopsy in the past that might look like lesions in an MRI?
Very interesting but not sure what to make of that with the Prednisone. It does seem to suggest you may be dealing with an inflammation/prostatitis of some sort if it's not your prostate size and not your bladder. Have you followed this line of thought with your urologist? They tend to rush to their go-to treatment a lot when presented with significant bph symptons without really thinking things through. I guess that's why these procedures work on some but not on others.
Neil, I thought I would tell you of a conversation I have had with two different IR doctors who examined my MRI and they tell me that in the process doing many focal laser ablation of the PCa in cancer patients, the patients showed in a large number of cases to also have their BPH sympthoms dramatically improve as a result of the FLA treatment on the lesions. Of course, this is after the IR does a Focal Laser specific biopsy of the tissue.
This realization has caused at least 3 IR doctors to start a protocal of using FLA to target and remove specfic BPH tissue in patiets who do not have PCa. But, my point to you is if you have a lesion that needs to be focally laser removed, the IR could also remove the specific tissue that is near your urethra and correct your sympthoms. On my MRI you can see the specfic tissue that is pinching the urethra. Just something to consider. Maybe you can have a solutition for both with one treatment.
My prostate Volume is 125 and I also have one dark suspicious spot on my 3TMRI in the center lobe. Though they do not think it is PCa, we have discussed going ahead and removing it when they treat the BPH causing tissue. Why not be safe and remove it is my thought for my situation. In reviewing my MRI with each of them, they could see and showed me the improtant nevers of the gland, the seminal vesicals, vas deferans, as well as the entire urethra and the block area. They also could give me a good report on my baddler condition.
All of the FLA procedure is done without entering the urethra with the laser. if you need any contact information of names, please private message me and I will provide. I was not charged for the consultations.
Good luck buddy. I know you are worried. Breath deep and research, you will find your answer.
The lymph node report is great news. If you only have one small area of a possible 7mm tumor than this is a very small amount of prostate cancer and should be easily treatable.
I had a number of little tumors in several parts of the prostate, Gleason grade 6 - so very low risk. However, due to the number of positive cores and percent of cancer in each core, I decided to move forward with treatment after a year and a half of active surveillance.
I interviewed many doctors - each one did a different type of treatment. I decided to go with HDR Brachytherapy - high dose rate radiation. I had two sessions, spaced two weeks apart. This was in Sept. 2014. The only after effect was tissue swelling after the second treatment and as a result I had to have a Foley catheter for 5 weeks until the swelling went down and I was able to urinate on my own again. This happens in about 10% of patients - I have an enlarged median lobe that became swollen and cut off urine flow.
My PSA is now down to 0.1 and I could not be more pleased with my decision to move forward with the radiation. I have a friend who had his prostate removed at exactly the same time as I had my HDR, and he is still having issues controlling his urine.
NOT being treated and being biopsied and MRId over and over again is much worse than just being treated. Now, I have peace of mind - a tremendous relief from the constant concerns I had before my procedure. No more poking and scanning and reports and anxiety. Just a quarterly (soon to be semi-annual) PSA test.
You are very perceptive as usual - when I told my previous uro he shrugged it off but then added that I would then be an even better candidate for a turp! He didn't explain but I guess he meant that I did not have any physical obstructions other than the inflammed tissue. My second uro just looked at me with glazed eyes.
But my feeling is that my BPH is a chronic inflammation due to an auto-immune disease similar to my COPD. It may have started decades ago with acute prostatitis that wasn't treated at the time but that doesn't matter anymore. Last summer I was given prednisone for an asthma attack and that was when I noticed it cleared up all my peeing problems. This past summer I went into AUR just a month before my PAE. But rather than go to the ER I took one 50mg pill and that had me peeing like a race horse for 3 days. I used that time to travel to Detroit where I got a lesson in CIC.
Persue your theories before committing to any operation or procedure. You have CIC as a safety valve to empty your bladder and protect your symptons. Curious, how long did it take for the 50mg of Prednisone to start working?
I can't get over the "even better candidate for a TURP" guy. Ha.Ha. Priceless. I guess that's what you get when you go to a one trick pony.
Thanks so much for this information j12080. This is all new to me and my head is swimming. I thought I was an "expert"on BPH and now I am a novice again. I have printed out your note here.
One question I have: Did you consult at all with any urologists or are you working exclusively with IRs?
Also did you ever have previous TRUS guided needle biopsies and if so did the scars show up in the MRI?
I wish you all the best too and thanks for your kind words. Neil
Following what you said, would it make sense to approach your system as a chronic nonbacterial prostatitis? Not a fan of antibiotics when unecessary, but sometimes a long course works for this. Possibly because antibiotics can have an anti-inflammatory effect in addition to its antibacterial properties. Or perhaps look at other ways to cut down the inflammation, possibly in the alternative medical arena. Not to say you should't keep working with urologists, but it sure gets tiring saying "no" all the time to whatever procedure or operation they are using
Thanks Tom - that is very helpful - I never heard of such a treatment. I don't have a median lobe but just lots of inflamed transitional zone tissue. So I guess that would get more inflamed but maybe steroids like prednisone would keep it down. Anyway, thanks to jimjames I have learned to self-cath so maybe I could avoid the Foley.
What part of the country do you live in? I am near Detroit. Was the procedure done by a urologist or IR?
Thanks for helping me and I wish you all the best. Neil
Earlier this evening I asked Dr. Moon about the procedure Tom is talking about. (see link below) Don't know enough about the procedure to know if Dr. Moon is correct, but I will say that it's been very hard to find much info about the procedure. Been around for more time than Rezum but only one doctor seems to be doing it, and haven't heard anyone here report they have had it -- all of which gives some pause.
I really cannot thank you enough for all the time you have taken to help so many guys stay with their self-cathing. I only first learned about it from you last spring but never thought it would happen to me (AUR). But when it did I knew where to go for a lesson. Still with so many catheter styles your posts helped me to sort through it and get on the Speedicaths. Also I would not have stayed with it w/o your constant help to me and others. I still do not like it but the alternatives are far worse. And now I have a life-boat to help me through this new problem. So for all the dozens of guys you brought to CIC - thanks Jim.
It took about 6 hours for the prednisone to restart my peeing and about 12 hours to really kick in. It really was like the fountain of youth in every possible way but it is such a potent and dangerous steroid at that level.
Actually my old uro was a 2 trick pony - he also offered me a prostatectomy!
Chronic prostatitis is so difficult to treat because there are so many hiding spaces for the bacteria in the prostate tissue. Also those little buggers learn to cover themselves with a mucous membrane that is impermeable to most drugs. Anyway, once the auto-immune effect kicks in over time even eliminating the original source of irritation will not generally break the auto-immune/inflammation pathology.
So I try to focus on taking a lot of natural anti-inflammatories/anti-oxidants like Co Q-10 and curcumin and quercetin and vitmain C but I cannot swear by it.
Also it is curious that NSAIDs like ibuprofen have no effect on my BPH whereas steroids like prednisone clear it up.
Neil. Yes, I went to 3 Uros prior to finding out about IRs. All did a DRE and told me it was soft tissue and was slightly swollen with a PSA of 4.2. All wanted and pushed hard to do a 12 needle blind biopsy. I said no and found an IR who did a 3TMRI with a pelvic coil not a rectal. After he read it I sent it to a IR who did focal laser ablation of PCa as I, like you, was concerned first that I had cancer. I then found out this IR agreed with the IR who did the MRI, that I did not currently have PCa. But the Uros totally missed it. My PSA was high because of the size of the prostate and not only slightly swollen. It was very large and therefore a high PSA number but no cancer. Still I had BPH so I changed direction and stopped worrying about PCa. Then with research I found PAE and the possible help from FLA. FLA fits me now as I can get rid of the dark spot I told you about and get it removed and reduce the tissue blocking the urethra at the same time with no sexual side effects and it is a quick recovery and results are faster than waiting on PAE shrinkage. Cath is about the same time for either. Cost does not matter, only results. I will borrow the money to get my life back.
Please keep me posted as to your journey and if I can help with any other comments.
